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TO THE C1.~;RK OF TNE CIRCUIT COURT, ~
sT. ~uc ~ e _ couNr~r, r~.otunA: . . .
Tbis is my deduation ot Domicile and Citi:aeahip In tbe State ot Fbrida U,at I am i~ing tlds d~y in aceord~aos. uid ia ,
eoato~mIty with Sectioa 2?2.17. Flortda Stdutes. '
1 w~s to~ a kgal reaid~at ot .~„~1.~~ ~ipd I • j
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resldcd ~t ~3 y___._ ~•~P~~ ~P ~~/l~ /!//~l~owevcr. I hava eban~d my domic~e to
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and un aad lu?vc b~ea a bona !'~de resideat oi ihe State of Fbrida sIaee ~ day ot
~D 1~ , ]8„ aad I reside at a~~,~ ~ ,~~,~/Q _
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ST. LUG 1 E ~„~y.
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and this ataternent is to be takea as aq~r declaratioo of eitiunsbip. actual kgal residenee and damic~ iu ihe State oi Floride.
Ii POR THE PURPOSE OF EMROLIING . IF POR HON£STEAO PURPOSES~
CHII.DREN IN SCHO01.~ PLEASE STATE PI.EJISE CHECK2 ~
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I FUR1'HER CFRTIFY that I will regL~tcr at my local addres~ when tbe registration books reopen, and corr.piy with al!
olhcr requircments oi a lcgal resident o! this Stale. - ~
1 FURTl~E~ CERTIFY thst I have ao intention ta rclurn to my former domiu'le. and I intcnd to remain in
' ' ~ ST . L U C 1 E . Cc?unty.
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~ Fbrida, permancnti; . • ~
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~ Sworn to nnd sul~. ~ " ~ ~ `aore mo thi~ day o( ~ ~„_,L-_.
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~ ROGf-_R P01 AS GLI:RK OF C IRGUI T COUtT
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~ ST. L ll~ I L COUNTY, F LOR 1 U ~
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~ BOOK 243 PACE .
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